Community Health Center Transportation in 2027: How to Win Ride Contracts with Health Centers

A community health center is a clinic that receives a federal Health Center Program grant to serve an area short on care, whatever patients can pay. Transportation is part of that job by law, and many centers buy it instead of running their own vans. That makes each one a possible customer that pays your invoice directly.

Why health centers pay for patient rides

Federal law lists the primary health services every center funded under Section 330 must provide. One of them is services that enable people to use the center, “including outreach and transportation services” (42 U.S.C. 254b(b)(1)(A)(iv)). The program rule says transportation must be provided as needed, so that residents of the service area with special difficulties of access get the center’s care (42 CFR 51c.102(h)(5)).

HRSA, the agency that runs the program, defines transportation as services that get patients to the center when travel would otherwise keep them from care. Its examples are vans, bus tokens or vouchers, and links to other community programs. Each center records how it delivers the service on Form 5A, and HRSA’s compliance FAQ (added March 8, 2023) sorts it three ways:

• Column I, directly. The center runs its own vehicle, buys bus tokens, or arranges and pays for taxis itself.
• Column II, by written contract. The center pays another organization under a contract or agreement, such as a county senior van, a taxi company, or a rideshare account.
• Column III, by referral. The center connects patients to a community program but pays nothing.

Column II is where you fit. A center in Column III has no budget for you yet. A center in Column I may still buy overflow trips, wheelchair rides, or rides its own van cannot reach. HRSA treats a contract for a service missing from Form 5A as a scope finding, so a center that signs with you may also need to update its form.

How much health centers spend on transportation

The money is real but spread thin. For calendar year 2025, HRSA’s Uniform Data System (UDS) counted 1,356 funded health centers serving 32,746,392 patients. They reported $141,897,313 in transportation costs out of $54.7 billion in total costs, or about $4.33 per patient. They also reported 1,219.37 full-time equivalent transportation staff.

The UDS Manual for 2025 counts van drivers and patient transportation coordinators as transportation staff, including anyone who arranges taxi or bus vouchers. Transportation cost includes salaries, supplies, equipment depreciation, travel, and contracted services. Bus tokens show up as cost with no staff, which is how a per-trip or per-mile contract with you would look too.

Most single centers spend modest amounts. HRSA publishes each center’s yearly UDS report in a downloadable file, minus tables a center keeps confidential. In the 2025 file (refreshed May 7, 2026), 681 centers’ cost tables are public. Of those, 335 reported any transportation cost, and half of the 335 spent $60,090 or less. Of the 711 public staffing tables, 199 show transportation staff, with a median of 1.65 full-time equivalents.

What health centers spent on rides in 2025, by state

California’s centers spent the most on transportation in 2025, $53.3 million, followed by New York at $10.0 million, Alaska at $7.6 million, and Utah at $6.0 million. In most states the total across every center is under $3 million. Spending is listed under the state where each center is based, and staff are full-time equivalents.

State	Health centers	Transportation cost	Transportation staff
Alabama	17	$781,662	9.71
Alaska	27	$7,602,856	42.07
Arizona	23	$4,642,366	57.09
Arkansas	12	$2,539,010	35.50
California	170	$53,295,937	224.82
Colorado	19	$801,272	8.28
Connecticut	16	$529,186	3.34
Delaware	3	$126,195	2.30
District of Columbia	8	$398,207	2.27
Florida	47	$4,107,989	36.11
Georgia	35	$905,841	12.64
Hawaii	13	$768,759	13.63
Idaho	14	$488,941	6.47
Illinois	45	$2,200,946	21.64
Indiana	26	$337,669	6.97
Iowa	14	$572,606	4.74
Kansas	19	$1,171,535	17.54
Kentucky	25	$772,519	13.70
Louisiana	35	$2,650,078	29.80
Maine	18	$272,918	3.49
Maryland	16	$2,011,162	18.83
Massachusetts	37	$4,781,919	54.42
Michigan	39	$2,660,577	36.64
Minnesota	16	$737,553	5.91
Mississippi	20	$825,802	13.98
Missouri	27	$2,545,817	30.03
Montana	13	$46,993	1.00
Nebraska	7	$573,944	11.90
Nevada	7	$997,765	23.97
New Hampshire	9	$415,295	3.85
New Jersey	23	$935,333	13.17
New Mexico	16	$1,241,103	19.25
New York	64	$10,023,813	77.31
North Carolina	38	$2,065,084	25.10
North Dakota	4	$76,860	1.53
Ohio	51	$2,368,371	41.10
Oklahoma	21	$1,134,224	13.96
Oregon	30	$1,687,592	6.72
Pennsylvania	40	$1,706,354	20.08
Rhode Island	8	$199,761	3.40
South Carolina	23	$2,650,836	27.19
South Dakota	4	$193,370	0.83
Tennessee	29	$471,220	8.24
Texas	71	$2,490,262	28.51
Utah	12	$6,027,111	54.49
Vermont	11	$121,182	0.00
Virginia	26	$954,006	17.06
Washington	27	$903,896	7.62
West Virginia	28	$469,285	8.67
Wisconsin	16	$197,600	1.01
Wyoming	5	$47,970	0.00

Many transportation staff, as in Arizona or Massachusetts, can mean centers run their own vans or employ ride coordinators, so pitch overflow, wheelchair, and long-distance trips there. Spending with almost no staff, as in Vermont, points to rides bought from others.

Which rides a health center pays for

Many health center patients have a ride benefit of their own. By main insurance in 2025, 47.5 percent of patients had Medicaid, 11.6 percent Medicare, 23.0 percent private insurance, and 17.2 percent none. Of patients whose income was known, 67.7 percent lived at or below the federal poverty guidelines.

Medicaid members already have a ride benefit, because each state must ensure necessary transportation to and from providers (42 CFR 431.53). So a center’s own money mostly goes to the rides no program covers:

• Uninsured patients, who have no ride benefit at all.
• Medicare and privately insured patients whose plan has no ride benefit. See does Medicare cover NEMT.
• Same-day sick visits and follow-ups booked too late for the Medicaid broker’s notice rules. See same-day NEMT trips.

Bill one payer per ride. If a trip runs through the Medicaid broker, the center does not pay it too. Section 330 also requires that no patient be denied care for inability to pay, so send every health center ride to the center’s invoice and let the center decide what, if anything, a patient pays.

Who decides at a health center

Three groups shape a transportation contract.

• The governing board. Section 330 and 42 CFR 51c.304 require a board of 9 to 25 members, most of them patients of the center. It meets at least monthly, selects the services the center offers, approves the annual budget, and approves the chief executive. A new transportation service starts here.
• The chief executive. The center directly employs its director, whom the board approves, and every purchase follows the center’s written procurement procedures. Ask who those procedures let sign.
• The enabling services staff. HRSA’s newer data tables call this work patient support services. Case managers, community health workers, and patient transportation coordinators are closest to the patients who miss visits for lack of a ride. They are your first meeting and your best source of the real problem.

Before you call, look the center up. HRSA’s Find a Health Center lists every site, and the market research guide shows how to map them against your service area. In HRSA’s UDS awardee file, find the center by name on the HealthCenterInfo tab, then read its transportation cost (line 11b) on the Table8A tab and its transportation staff (line 27) on the Table5 tab. Three dashes mean the center kept that table confidential. A center with cost and no staff already pays others for rides or bus tokens. A center with neither is a candidate for a first contract.

How health centers buy rides: the federal purchasing rules

When the federal grant pays for a purchase, the center must use its own written procurement procedures, and they must conform to 2 CFR 200 (HRSA Compliance Manual, Chapter 12, last reviewed December 2025). The amount sets the method (2 CFR 200.320):

Contract size	What the center must do	What you send
Up to the micro-purchase threshold	Document that your price is reasonable	A written quote and rate sheet
Above that, up to $350,000	Get price or rate quotes from an adequate number of sources	A quote that answers the same scope as others
Above $350,000	Use sealed bids or proposals with public notice, plus a cost or price analysis	A full proposal by the deadline

Since October 1, 2025, the Federal Acquisition Regulation has set the micro-purchase threshold at $15,000 and the simplified acquisition threshold at $350,000 (48 CFR 2.101), and those figures still apply as of October 2026. A center may self-certify a micro-purchase threshold of up to $50,000 a year, and it may set lower limits. Noncompetitive deals are allowed only for micro-purchases, a true single source, an emergency, written HRSA approval, or when competition proves inadequate.

Three more rules affect you:

1. Exclusion checks at $25,000. A contract expected to reach $25,000 under a federal award is a covered transaction (2 CFR 180.220). The center must confirm you are not excluded by checking SAM.gov, collecting your certification, or adding a contract clause (2 CFR 180.300). Check your own record first. See SAM exclusions.
2. What the contract must say. Contracts that support the center’s approved scope must spell out the services, how the center monitors your work, and the data you provide for its federal reports. They also cover record retention and access, audits, and property. Contracts for in-scope health services carry a schedule of rates and a payment method.
3. Records for three years. The center keeps contract records for three years after its final financial report, and it needs access to your records about its work.

HRSA’s FAQ adds that contracts for enabling services, transportation included, do not need the clinical terms required for medical care, such as notes in the patient record or follow-up care. A ride contract can stay short. Contracts paid entirely from other money, such as a foundation grant, follow the center’s own procedures. Ask which money will pay you.

Pricing a health center contract inside the kickback rules

Price health center work from your own cost: by the vehicle mile or hour for each level of service, plus wait time, or a fixed rate for a set schedule. The NEMT pricing guide and the rate sheet template walk through it. Two federal safe harbors shape the terms.

When the center gives patients free rides. The local transportation safe harbor, 42 CFR 1001.952(bb), protects free or discounted rides for established patients within 25 miles of the provider, or 75 miles for a patient who lives in a rural area. The rides must follow a set policy applied uniformly, cannot be publicly marketed or advertised, and cannot be luxury, air, or ambulance-level. No one may market health care during the ride, and drivers or anyone arranging rides cannot be paid per patient carried. The center must bear the cost itself, without shifting it to any federal program, other payer, or patient. When OIG adopted the rule, it said a center that hires a private company for these rides cannot pay it per patient transported, but could pay by the total distance the vehicle travels (81 FR 88387, December 7, 2016). Price by the mile, the hour, or a fixed schedule, and ask the center’s compliance officer to approve the terms.

When you offer the center a discount. The health center safe harbor, 42 CFR 1001.952(w), names transportation as an enabling service a company may provide to a center free or at a reduced charge. It protects that arrangement only when:

• It is in writing. A signed agreement states the amount of the discount, which cannot depend on the volume or value of federal program business between you.
• The center expects a real benefit. It documents beforehand why the deal should improve care for the people it serves, and it re-evaluates the deal at least once a year.
• Referrals stay free. You cannot require the center to refer patients to you, or stop it from referring them elsewhere.
• Every patient qualifies. You serve every qualifying patient the center sends, whatever their insurance or ability to pay. You may cap the total volume, but not by insurance.
• The center keeps its options. It stays free to contract with your competitors, and patients are told they may choose any willing provider.

Never give staff gifts or anything of value for Medicaid referrals. See anti-kickback rules for NEMT.

How to pitch a health center, step by step

1. Find the centers near you. Use HRSA’s map and sort the sites by distance from your garage.
2. Read their numbers. Check each center’s transportation cost and staff in the UDS file, and your state’s totals in the table above.
3. Call the enabling services lead. Ask who coordinates patient rides and which visits patients miss for lack of one. Common gaps are wheelchair patients, same-day visits, and rides from far corners of the service area.
4. Offer a small, clear service. Start with one kind of trip, such as wheelchair rides to the main clinic two days a week, priced under the center’s micro-purchase limit.
5. Send a one-page quote. List your service area, hours, vehicles, response times, rates, insurance, and NPI or Medicaid enrollment if you have them. Use the facility agreement template as the starting contract.
6. Report every month. Send the rides completed, on-time rate, no-shows, and cost per ride. The center reports its transportation cost to HRSA each year (the 2025 UDS report was due February 15, 2026), and its board wants to see what the money bought.
7. Grow at budget time. Ask when the board approves next year’s budget, and bring your numbers before that meeting.

For how facility accounts work in general, see NEMT facility contracts. For marketing visits that bring steady referrals, see NEMT marketing.

What to put in the agreement

Build the contract around the rules above so the center can approve it fast:

• Who qualifies. The center decides which patients get a ride and books them in writing. You never decide eligibility.
• Service and booking. The service area, hours, levels of service, lead time, and how same-day and return rides are handled.
• Rates and invoices. One schedule of rates, a monthly invoice with trip-level detail, and a payment due date.
• Reports. The ride data the center needs for its board and its federal reports, delivered each month.
• Records and audits. Trip records kept at least as long as the center needs them, with access for the center and federal auditors.
• Exclusion certification. A statement that your company and staff are not excluded, renewed each year.
• Privacy. Patient names and appointment times are health information. Expect the center to require a business associate agreement, and train your staff under the HIPAA guide.
• Insurance and term. Your limits, the center as additional insured if it asks, a set term, and notice to end.

A private nonprofit health center can also receive federal Section 5310 transit money through its state, or in a large urban area through the area’s designated recipient, for projects that serve older adults and people with disabilities (49 U.S.C. 5310). If a center buys its own van that way, offer trained drivers, maintenance, or backup trips. See Section 5310 grants.